小罗伯特·F·肯尼迪时代的儿童疫苗

嗨。

Hi.

我是安迪。

This is Andy.

我多年来一直是《纽约时报》的订阅用户，现在正努力让我的青少年子女对阅读它产生兴趣。

I've been a New York Times subscriber for years and years, and I'm trying to get my teenagers interested in reading it.

如果他们能拥有自己的登录账号，我们可以共享文章，我认为这会有助于激发他们的兴趣。

If they were to have their own logins and we could share articles, I think that would help get them interested.

这样我们也可以在餐桌旁或任何地方一起讨论。

It would also then allow us to discuss over the dinner table or wherever.

非常感谢。

Thank you very much.

安迪，我们听到了你的意见。

Andy, we heard you.

推出《纽约时报》家庭订阅。

Introducing the New York Times Family Subscription.

一个订阅，可为生活中最多四人提供独立登录账号。

One subscription up to four separate logins for anyone in your life.

了解更多，请访问 nytimes.com/family。

Find out more at nytimes.com/family.

来自《纽约时报》，我是蕾切尔·阿布拉姆斯，这里是《每日新闻》。

From The New York Times, I'm Rachel Abrams, and this is The Daily.

本周早些时候，美国疾控中心发布了新指南，大幅削减了联邦政府推荐的儿童疫苗接种数量。

Earlier this week, the CDC released new guidelines which dramatically cut down the number of childhood vaccines recommended by the federal government.

今天，我的同事本杰明·穆勒和阿普尔瓦·曼达比利将解释哪些疫苗被削减，这如何符合卫生部长罗伯特·F·肯尼迪 Jr. 的更大议程，以及这对公共健康更广泛的影响。

Today, my colleagues Benjamin Mueller and Apurva Mandabili explain what's being cut, how this fits into the broader agenda from health secretary Robert f Kennedy junior, and the broader implications for public health.

今天是1月8日，星期四。

It's Thursday, January 8.

本、阿普尔瓦，非常感谢你们今天来到这里。

Ben Apoorva, thank you both so much for being here today.

很高兴能来。

Glad to be here.

非常感谢你们邀请我们。

Thanks so much for having us.

自从罗伯特·F.

So ever since Robert F.

肯尼迪 Jr. 被确认为卫生部长以来，人们一直对他是如何试图重塑公共卫生政策充满疑问，尤其是涉及他多年来公开持怀疑态度的疫苗问题。

Kennedy junior was confirmed as the health secretary, there have been all kinds of questions about how he might seek to reshape public health policy, particularly as it relates to vaccines, which he has been openly skeptical about for years.

本周，我们看到了这方面的首批重大变化。

And this week, we saw some of the first major changes on that front.

我想谈谈这些变化、他为何做出这些改变，以及对公共卫生的影响。

And I wanna talk about the changes, why he made them, the implications for public health.

但首先，阿普尔瓦，你能给我们解释一下哪些疫苗受到了影响吗？

But first, Apoorva, can you just explain to us what vaccines were affected?

在周一之前，美国儿童通常需要接种针对17种疾病的疫苗。

So before Monday, American children were supposed to routinely get vaccines for 17 diseases.

周一，肯尼迪部长及其助手等其他卫生官员表示，儿童疫苗接种计划将被缩减，现在常规推荐的疫苗仅针对11种疾病。

And on Monday, secretary Kennedy and his associates, the other health officials, said that that vaccine schedule for children would be paired down so that now routine recommendation includes vaccination against 11 diseases.

那么取消了哪六种呢？

And which six were taken off?

现在被不同对待的六种是呼吸道合胞病毒（RSV）。

So the six that are now being treated differently are respiratory syncytial virus, RSV.

RSV。

RSV.

是的。

Yes.

轮状病毒、甲型和乙型肝炎、脑膜炎球菌疫苗（主要用于预防脑膜炎），以及流感疫苗。

Rotavirus, hepatitis a and b, meningococcal vaccines, which are really for meningitis, and influenza.

我想澄清一下，当我们说它们被取消时，实际上它们仍在推荐清单上。

And I wanna clarify here that when we say they were taken off, they are still on the recommendations.

只是推荐方式不同了。

They're just recommended differently.

理论上，这些疫苗仍然都在接种计划中，但现在它们仅推荐给特定的高风险群体，或者如果你不属于这些群体，应在接种前先咨询医生。

So in theory, these vaccines are still all on the schedule, but they are now being recommended either for certain high risk groups or if you don't fall into one of those groups that you should consult with your doctor first before getting them.

因此，实际上这意味着更少的人会接种这些疫苗，更多人会感到困惑，而我所接触的公共卫生专家认为，这将从根本上削弱公众对疫苗的信任，人们会开始认为这些疫苗根本没必要。

So what it actually means in practice is that fewer people will get them, more people will be confused, and the public health experts that I've been talking to feel that this will actually undermine trust in vaccines in a very broad way, and people will start to think they're not really necessary at all.

本，你能告诉我们，肯尼迪部长和疾控中心为何认为这一改变是必要且明智的吗？

And, Ben, can you tell us a little bit about what the argument is from secretary Kennedy and the CDC for why this change was necessary and a good idea?

肯尼迪多年来一直在宣传疫苗的危险性，甚至连特朗普也采用了类似的说法，暗示孩子接种了太多针剂，可能带来某些风险——但医生们认为这些风险在实际证据中并不存在。

Kennedy's been campaigning about the dangers of vaccines for years, and even Trump has sort of adopted that language about kids getting too many shots with sort of vague reference to the dangers that that might hold for kids, dangers that doctors don't believe are actually reflected in the evidence.

在这种情况下，肯尼迪将丹麦作为他的典范，这个国家的疫苗接种计划比美国简单得多，而且它是一个规模小得多、医疗体系也截然不同的国家。

In this case, Kennedy has sort of taken Denmark as his model, a country that has a much more minimal vaccine schedule than than The United States, a much smaller country with a very different health system.

在那里，他们的想法似乎是想重塑美国的疫苗项目，使其适应一个更加精简的接种时间表，不再试图解决美国医疗体系中的所有问题和缺陷，也不再应对美国人口的所有医疗需求，而是主张：应该建立一个更加个体化的新体系，每个孩子都需根据自身情况，咨询医生的个性化建议，而不是采用一刀切的方式。

And the idea there seems to be that they want to refashion the American vaccine program to sort of fit a much more pared down schedule so it no longer tries to address all of the problems and fallibilities with the American health system, all of the medical needs of the American population, and instead say, you know, there should be a new system that's much more individualistic, where each kid is consulted on their particular needs, and the particular advice of their doctor, rather than a sort of one size fits all.

让我们来决定什么最有利于美国人口的健康。

Let's decide what's best for the health of the American population.

总体而言，这似乎正是当前正在发生的事情。

Generally, that seems to be a little bit of what's going on here.

这感觉与肯尼迪之前反复强调的理念高度一致：人们应该对自己的身体和健康拥有自主权。

It feels very spiritually connected to this idea that we've heard from Kennedy before about people should have autonomy with their own bodies, their own health.

他们应该能够自己做决定。

They should be able to make their own choices.

对吧？

Right?

没错。

Right.

这种对集体思考美国人群体健康的抵制。

And this sort of resistance to collective thinking about the collective health of Americans.

他们自称为医疗自由运动。

They brand themselves as a medical freedom movement.

嗯。

Mhmm.

我的意思是，在这种情况下，疫苗接种时间表本身并不强制要求接种这些疫苗。

I mean, in this case, the vaccine schedule does not itself mandate the taking of these shots.

这是由各州层面决定的。

That's happening at the state level.

所以，肯尼迪实际上并没有通过这一决定真正让任何人摆脱接种这种或那种疫苗的繁重义务。

So Kennedy hasn't actually sort of, in practice, freed anybody from onerous obligations to take this or that shot with this decision itself.

但没错，他们正试图让这件事变得更加个案化。

But, yes, they are trying to make this a much more case by case.

你和医生谈谈，你有权决定你的孩子应该接种哪些疫苗。

You talk to your doctor, and you have the power to decide what shots your kid should be taking.

我可以问一个问题吗

Can I just ask a

不过关于这一点，我想问一下？

question about that though?

因为我们都知道医生有多匆忙，医疗专业人员有多缺乏时间。

Because I we all know how rushed some doctors are, how little time medical professionals have.

我觉得，那些对疫苗持怀疑态度的人经常提出的批评或反驳是：实际上，我并没有阅读信息单。

And I feel like one of the criticisms or pushback to that that you hear from people that are skeptical of vaccines is that, well, in practice I'm not reading the information sheet.

我也没有提供信息单。

I'm not giving the information sheet.

医生没有跟我详细说明风险。

The doctor's not going over the risks with me.

对这个观点有什么回应？

What is the response to that idea?

但这是一个合理的观点。

But that's a fair point.

医生并不总是有时间

Doctors don't necessarily always have time to

来详细讲解这些内容。

go through these things.

但理念是，如果家长有疑问，这就是他们可以讨论的方式。

But the idea is that if parents do have questions, this is how they can talk about it.

为此提供了一个交流平台。

There is a forum for that.

如果我们担心医生没有足够时间与家长详谈所有顾虑，那么我们通过在清单上增加大量疫苗，实际上将这个问题扩大了四倍——现在家长必须在接种前与儿科医生深入讨论每一针疫苗。

If we are worried about doctors not having enough time to talk parents through all of the concerns, well, we've just quadrupled that problem by putting a whole bunch of vaccines on the list that parents are now gonna have to really talk about with their pediatricians before they can even get the shot.

我还要说，过去将疫苗列入推荐接种清单的决定从来都不是轻率做出的。

I would also say the decision to put vaccines on this recommended slate of shots has not historically been taken lightly.

这一决定是在咨询医生、公众成员、专业团体之后做出的，这些建议随后逐渐融入了医疗实践。

It's happened after consultation with doctors, members of the public, professional groups, and those recommendations have filtered down into medical practice.

而且，一旦被采纳，它们之所以被采纳，是因为经过了广泛的研究，并被确认为安全有效。

And to the extent they've been adopted, they've been adopted because they were studied pretty extensively and determined to be safe and effective.

因此，那些 presumably 花了大量时间思考、研究、撰写和调查疫苗安全性的人员，医学和科学界是如何回应这些变化的呢？

And so the people that presumably have spent a lot of time thinking, studying, writing, researching the safety of vaccines, how are the medical and scientific communities responding to these changes?

他们大致可以分为两类。

They've been sort of broadly falling into two camps.

我想我接触过很多持乐观态度的人，他们希望儿科医生和家长真正认识到疫苗的价值，当真正面临选择时，人们会像以往一样继续接种，不会有什么太大改变。

I'd say I've talked to a lot of people who are optimistic, hoping that pediatricians and parents really recognize the value of vaccines and that when it really comes down to it, people will continue to go on as they always have and nothing much will change.

而另一些专家则 genuinely 非常担忧，因为他们已经看到一些家长前来询问：我听到的传言是，政府说这些疫苗不再需要了。

And then on the other side are experts who are genuinely really worried because they're already seeing some parents coming in saying, what I'm hearing is the government is saying these vaccines are not needed anymore.

那我还有必要打这一针吗？

And do I even really need to get this one?

我不知道。

And I don't know.

感觉太多了，等等。

Seems like too much, etcetera.

但几乎所有专家都同意，这造成了大量困惑，而公共健康领域中的困惑从来都不是好事。

But pretty much all of them agree that this is creating a lot of confusion and that confusion is never good when it comes to public health.

这里有一件非常快速、我认为很有趣的事情值得注意：他们一直在谈论丹麦。

One really quick, I think, interesting thing to note here is that they've been talking a lot about Denmark.

而对疫苗安全问题研究最多的人就在丹麦。

And the person who has done probably the most work on vaccine safety is in Denmark.

他是丹麦疾控中心的一员，我已经和他谈过几次了。

He's part of Denmark's CDC, and I've spoken to him a few times now.

他对这些决定感到非常困惑，完全不明白美国为何要这样做。

And he is just baffled by these decisions and does not understand why The US is doing this.

等等。

Wait.

解释一下这个。

Just explain that.

美国想效仿丹麦，为什么会让人如此困惑呢？

Why would it be so baffling that The US would wanna emulate Denmark?

丹麦是一个很小的国家，拥有无与伦比的医疗体系，免费的产前护理，以及对孕妇极其出色的筛查。

Denmark is a tiny country with impeccable health care, free prenatal care, really excellent screening of pregnant women.

他们决定减少疫苗接种的数量。

They have decided not to have quite as many shots.

他们只有10剂。

They have 10.

当我们谈论全球情况时，他们真的是个例外。

They're really the outlier when we talk about the world.

他们之所以这样做，是因为需要购买大量疫苗。

And they've done that because they have to purchase a lot of vaccines.

对于这样一个小国来说，疾病的负担有时并不能让这些疫苗具有足够的成本效益。

And for such a small country, sometimes the burden of disease doesn't make those vaccines quite as cost effective.

所以这实际上是一个经济决策。

So it's really an economic decision.

嗯。

Mhmm.

但在美国，我们没有那种严格的随访和免费医疗，无法让孩子的疫苗接种被忽视，甚至可能生病。

But in The United States, we don't have the kind of rigorous follow-up and free care that would make it okay for a kid to not be vaccinated and maybe get sick.

因为在丹麦，这个孩子会立即得到诊治，父母无需支付费用或只需支付极少费用。

Because in Denmark, that kid would get seen right away, get treated right away at zero or very little cost to the parents.

而在这里，预防才是最佳选择。

Whereas here, prevention is really the best option.

显然，所有这些从接种计划中移除的疫苗，它们各自发挥不同的作用。

Obviously, all of these vaccines that are coming off the schedule, they all do different things.

它们都有不同的背景故事。

They have different backstories.

但我好奇我们是否可以挑选其中一个作为重点，来帮助我们解释我们是如何走到这一步的。

But I wonder if we can pick one to focus on that might help us explain sort of how we got to this point.

比如，你能告诉我某种疫苗是如何被纳入儿童接种计划，后来又成为目标的吗？

Like, maybe you can tell me about how a particular vaccine got added to the childhood vaccine schedule and then later became a target.

我认为乙型肝炎是一个非常有趣的例子。

I think hepatitis b is a really interesting example here.

这是一种高度传染性的病毒，可能非常危险，会感染肝脏，并通过血液和其他体液传播。

This is a virus that is highly contagious, can be very dangerous, it infects the liver, and it spreads through blood and other bodily fluids.

因此，在二十世纪八十年代初经过多年的研究，科学家们研发出了一种疫苗。

So finally, after years of work in the early nineteen eighties, scientists developed a vaccine.

它非常有效。

It's highly effective.

它安全可靠，联邦卫生官员决定推荐给他们认为感染风险较高的群体，比如静脉注射吸毒者和男男性行为者。

It's safe, and federal health officials decide to recommend it to groups that they deem to be at high risk for the virus, which is intravenous drug users and men who have sex with men, for example.

人们对此充满乐观，认为终于能够遏制这种病毒的蔓延。

And there's a lot of optimism that they're finally gonna turn back the tide of this virus.

但事与愿违，情况恰恰相反。

Instead, the opposite happens.

乙型肝炎病例持续上升。

Cases of hepatitis b keep climbing.

数十万人受到感染。

Hundreds of thousands of people are getting infected.

我认为在这个故事中，我们看到了最初疫苗接种策略中存在的某些漏洞。

And I think in that story, we learn about what some of the holes were in that initial vaccination strategy.

哪些漏洞？

Which were?

嗯，第一个疫苗接种策略的一个问题是，医生实际上并不擅长识别哪些患者会从疫苗中受益。

Well, so one problem with that first vaccination strategy was that doctors turned out not to be very good identifying which patients would be well served by the vaccine.

嗯。

Mhmm.

而这些患者中的一些人要么不知道自己应该接种疫苗，要么因为害怕疫苗而抗拒接种。

And some of those very patients either didn't know that they should get the shot or were resistant to getting it because they were afraid of the vaccine.

这是一种新型疫苗。

It was a new vaccine.

当时流传着一些虚假的谣言，称这种疫苗可能导致艾滋病。

There were sort of false rumors spreading that it might be causing HIV.

还有一个第二个问题，就是医生们并没有总是识别出这种病毒实际上在哪些人群中间传播。

There was also a second problem, which is that doctors didn't always recognize in what patient populations this virus was in fact spreading.

这包括许多儿童，他们中许多人感染了病毒，其中一些人多年后因此出现了健康问题。

That included kids, many of whom were getting infected, some of whom were facing health problems years down the road from this virus.

而这些儿童并未被最初的疫苗接种策略覆盖，因为该策略只针对高风险成年人。

And those kids were not covered by that first vaccination strategy, which focused on high risk adults.

每年儿童中的病例大约有两万例，而且并非所有病例都是通过母亲传播的，而母亲传播曾被认为是主要传播途径。

There were something like twenty thousand cases a year in children, and not all of them were even getting the virus from their mothers, which was thought to be the main mode of transmission.

当时的研究表明，这些幼儿中大约有一半的感染源不明，可能是来自社区中的其他儿童或与他们同住的人。

There were studies at the time suggesting that something like half of the cases in these young children were of unknown source, potentially from other children in the community or from people they lived with.

因为你可以通过结痂的血液感染这种病毒。

Because you can get the virus from crusted blood.

你可以通过共用牙刷，或使用沾有干燥血液的毛巾而感染。

You can get it from a shared toothbrush or from a a towel that has dried Bahi material on it.

所以这是一种非常、非常具有传染性的病毒。

So this is a very, very highly infectious virus.

因此，他们开始意识到婴儿真的需要保护，并采取了几种不同的方式来应对。

And so they started to recognize that babies really needed protecting, and they went after this in a few different ways.

他们最初从高风险群体开始。

They started out initially with that high risk group.

他们将范围扩大到包括孕妇。

They expanded that to include pregnant women.

但在1991年，他们决定：好吧。

But in 1991, they decided, okay.

这种方法行不通。

This is not working.

我们真的需要保护这些婴儿，而唯一能覆盖每一个婴儿的方法就是在出生时接种。

We really need to protect these babies, and the only way we're gonna be able to get to every single one is to do it at birth.

因此，在初次推广十年后，联邦卫生官员重新召集会议，决定实际上应该建议对婴儿接种疫苗。

So ten years after that initial rollout, federal health officials reconvene and decide that, in fact, they should start recommending the vaccine to infants.

而且效果非常显著。

And it's remarkably successful.

在接下来的几十年里，儿童和年轻人中的乙型肝炎病例减少了约百分之九十九。

Over the next few decades, cases of hepatitis B fall in children and young adults by something like ninety nine percent.

这种疫苗被广泛接受。

The vaccine is widely taken up.

它安全可靠，包括对婴儿也是如此。

It's safe, including in infants.

它高度有效。

It's highly effective.

而正是这种接种婴儿的策略，现在被肯尼迪决定实际上废除。

And it's that very strategy, the strategy of vaccinating infants that Kennedy has now decided to effectively undo.

这里非常有趣的是，关于出生时普遍接种乙型肝炎疫苗的整个丰富历史，反而成了反疫苗人士广为传播的论点。

The really interesting thing here is that that whole colorful history of how the universal hep b vaccination at birth came to be also lent itself to becoming this very popular anti vaxx talking point.

他们开始声称，国家实际上是把所有婴儿都当作保护成人的安全网，给婴儿接种疫苗是为了保护这些高风险人群。

They started saying that, essentially, the country was vaccinating all babies as a safety net for adults, that they were vaccinating infants to protect these high risk groups.

而且你

And you

你必须记住，这是二十世纪八十年代末、九十年代初，当时艾滋病在全国肆虐。

have to remember, this is the late nineteen eighties, early nineties, a time when HIV is rampant in the country.

当时存在严重的恐同情绪，将同性恋者妖魔化。

There's all this homophobia, this villainization of gay people.

到处都是恐惧。

There's tons of fear.

但就在同一时期，科学家们也开始发现婴儿其实极易感染这种疾病。

But at that same time, scientists were also starting to figure out that infants were really at risk of this disease.

因此，这一切有助于解释为什么在这个国家，公共卫生政策发生了变化。

So all of that helps explain why in this country, public health policy changed.

这也解释了为什么它与MAHA运动发生了直接冲突。

It also helps explain why it has run squarely into the MAHA movement.

我认为这完全正确。

I think that's exactly right.

我认为，这些年来发展起来的疫苗计划，如今正与一个坚决反对‘一刀切’疫苗接种策略的MAHA运动正面碰撞。这个运动更倾向于一种个人化的儿童健康理念，对药物和疫苗充满不信任，认为它们是食物、空气和水中一系列污染物之上的又一种污染。

I think the vaccine program that developed over those years has now run headlong into a MAHA movement that is dead set against a one size fits all vaccination strategy that's much more interested in a sort of individualistic approach to the health of children, that distrusts drugs and vaccines and sees them as sort of another contaminant on top of a list of contaminants in the food supply and in the air and in the water.

这种观念也轻易地契合了肯尼迪关于保护美国人健康最佳方式的看法——与其通过接种疫苗来增强身体对疾病的防御能力，不如通过改善饮食等方式来实现。

And that also sort of sits on easily with this idea that Kennedy seems to have about the best way of protecting the health of Americans, which is rather than introducing vaccines into their body to strengthen their defenses against illness, to, for example, improve their diet.

我们看到，肯尼迪最近刚刚修订了美国的膳食指南，建议美国人多吃全谷物、蔬菜和更多蛋白质，这完全契合肯尼迪的策略核心：通过增强人体自身的抵抗力来对抗疾病，而不是通过接种疫苗来防范严重疾病。

We saw that Kennedy just recently remade the American dietary guidelines to recommend that Americans eat more whole foods, vegetables, more proteins, which fits squarely in the middle of this Kennedy strategy of trying to fortify people's own bodies, strengthen people's own resources against disease rather than vaccinating them as a sort of way to protect against very dangerous illness.

广告后，我们将探讨这些变化如今及未来意味着什么。

After the break, what these changes mean now and moving forward.

你知道吗？印度是全球最大的加密货币采用国，而爱沙尼亚在所有选举中都提供在线投票。

Did you know that India is the biggest adopter of crypto globally and that Estonia offers online voting in all its elections?

我是凯瑟琳·本霍尔特，《纽约时报》全新每日通讯《世界》的主持人。

I'm Catherine Benholt, host of The World, a new daily newsletter from The New York Times.

我曾有二十年时间在十多个各国进行报道，有一天我突然想到：我究竟想读什么样的通讯呢？

I spent twenty years reporting from more than a dozen countries, and it occurred to me one day, you know, what kind of newsletter would I like to read?

我不住在美国。

I don't live in The US.

我希望有一份专门为全球读者撰写的刊物，能帮助我理解正在发生的事情以及其重要性，最好还能让我感到振奋，而不是沮丧。

I want something that's written especially for a global audience, something that helps me understand what's going on and why it matters, and ideally something that doesn't just get me down.

这个世界正是如此。

The world is just that.

每个工作日早晨，我们会为您带来最重要的新闻、来自我们现场记者的报道，以及一些令人愉悦的视频惊喜。

Each weekday morning, we bring you the biggest stories, dispatches from my colleagues on the ground, and a few delightful surprises with video too.

《世界》简报，来自《纽约时报》。

The World Newsletter from The New York Times.

立即在 nytimes.com/theworld 注册，每天早晨直接收到邮件。

Sign up now at nytimes.com/theworld to get it in your inbox each weekday morning.

所以，波瓦，你之前说过，理论上这些疫苗仍然会提供给想要接种的人。

So, Porvah, you said earlier that theoretically these vaccines will still be available to the people that want them.

但显然，这些指南正在发生变化。

But, obviously, these guidelines are changing.

我可以想象，如果你是一位希望为孩子接种疫苗的家长，这一切一定非常令人困惑。

I can imagine that if you are a parent who wants a vaccine for your child, this is all very confusing.

人们该如何应对这种情况呢？

How are people supposed to navigate this?

首先，我认为非常重要的是，对于确实希望为孩子接种疫苗的家长来说，保险仍然会覆盖相关费用。

I think it's very important to know, first of all, that for parents who really want vaccines for their kids, insurance will still cover the costs.

他们不需要自费，而且可以找到愿意为孩子接种疫苗的儿科医生。

They will not have to pay out of pocket, and they can find pediatricians who will give them the shots.

在这种新方案中，共同临床决策的理念变得尤为重要。

This idea of shared clinical decision making is what became really important in this new schedule.

先和你的医生谈谈。

Talk to your doctor first.

因此，从实际角度来看，对于希望接种疫苗的家长和负责接种的儿科医生来说，新指南不会带来太大变化。

So on a very practical level, the new guidelines won't change much for parents who want the vaccines and pediatricians who are administering them.

对。

Right.

如果儿科医生原本就打算接种疫苗，那么这种情况不应该改变。

If pediatricians already wanted to give the vaccine, that should not change.

正确。

Correct.

即使你不属于

Even if you're not in

高风险群体，你也应该能够接种理论上仅限高风险人群的疫苗。

a high risk group, you should be able to get a vaccine that theoretically is only for high risk groups.

我认为我们真正会看到变化的地方是在个人层面，个别家长感到困惑，不确定该怎么做，而儿科医生可能没有足够时间向患者提供指导。

Where I think we're really going to see changes is at the individual level, where individual parents are confused and not sure what to do, and pediatricians may run out of time to counsel their patients on what to do.

我认为这才是事情真正开始出现裂痕的地方。

I think that's where things are really going to start to fray.

至于强制接种，这实际上是疫苗落实的关键，每个州都有儿童入托或上幼儿园的接种要求。

And then, you know, in terms of mandates, which is really where rubber hits the road for vaccines, every state has requirements for children to enter daycare or kindergarten.

这些要求在各州之间实际上非常相似，无论红州还是蓝州，差异都很小。

And those are actually very similar across states, blue and red, very few differences.

到目前为止，似乎这些要求也不会改变。

And so far at least, it seems like that may not change either.

我与纽约州卫生局局长交谈过，他一直在与红州和蓝州的同行们进行大量交流，他说没有人真的想改变任何事情。

I was speaking with the New York state health commissioner who's been having a lot of conversations with his colleagues in both red and blue states, and he was saying that nobody really wants to change anything.

所以除非州长介入，

So unless their governors intervene,

我认为情况会保持原样。

I think things will stay as they are.

但理论上，州长可以说：好吧。

So but theoretically, a state governor could say, okay.

疾控中心现在建议将这六种疫苗从接种计划中移除。

The CDC is now recommending that these six vaccines come off the schedule.

我希望我的州能有所改变，我会指示州卫生部门调整 preschool 所需疫苗的要求。

I want to see changes in my state, and I will direct my state health department to change the requirements for, let's say, the vaccines you need for preschool.

如果真的发生这种情况，解释一下接下来会发生什么。

And if that were to happen, explain what happens next.

实际情况是，他们可能会有

What happens is they will probably have

他们会面临一场斗争。

a fight on their hands.

因为疫苗，尽管你听到很多反疫苗情绪，但对大多数人来说仍然非常受欢迎。

Because vaccines, even with all of the anti vaccine sentiments you hear, are still really popular with most people.

对儿童接种疫苗有着强大的两党支持。

There's strong bipartisan support for childhood vaccination.

在一些人提出更改疫苗计划的州，情况并不总是顺利。

And in states where people have proposed making changes, it has not always gone well.

好的。

Okay.

所以听起来，即使目前州一级没有变化，正如你所说，阿普尔瓦，实际上会有更少的孩子接种这种疫苗。

So it sounds like even if things do not change for the time being at the state level, as you were saying, Apoorva, practically speaking, fewer kids are gonna get this vaccine.

要么是因为临床医生没有时间详细解释，要么是家长感到困惑，或者其他原因。

Either it's because the clinicians don't have time to go over the parents are confused, or perhaps other reasons.

因此，我们可以预期，这个国家将会出现一定程度的更多疾病。

And so therefore, we can expect that there will be more illness of some amount in this country.

我想知道我们是否对这一规模有所了解。

And I wonder if we have any sense of the scale of that.

对于某些疾病，我们在疫苗常规使用前是有一定数据的，对吧？

We have some idea for some of the diseases, right, from before the vaccines were in routine use.

所以，如果你想想轮状病毒，在疫苗常规使用前，每年大约有七万例儿童住院病例。

So if you think about something like rotavirus, before the vaccine was in routine use, there were something like seventy thousand hospitalizations in kids a year.

嗯。

Mhmm.

而这还是最坏的情况。

And that's the worst case scenario.

但也要记住，我们是一个人口众多的大国。

But also, it's important to remember, we're a big country with a big population.

因此，即使疫苗接种率出现很小的下降——我们国家已经出现了这种下降——也会导致相当数量的病例。

So even a small drop in vaccination rates, which we have already seen in this country, results in quite a few cases.

比如，我们现在就正在目睹麻疹疫情的蔓延。

You know, we're seeing that unfold now with measles, for example.

麻疹的疫苗接种率下降了大约两个百分点。

The vaccination rate for measles has fallen by something like two percentage points.

但今年，我们的病例数比上世纪九十年代中期还要多。

But this year, we've had more cases than in the mid nineteen nineties.

顺便说一下，接种率下降是因为公众宣传，而不是疫苗本身的变化。

And it's fallen, by the way, because of public messaging, not necessarily because of vaccine changes.

我应该指出，麻疹仍然在接种计划中。

Measles, I should note, is still on this schedule.

它仍在计划中。

It is on

在接种计划中。

the schedule.

接种率下降的原因是多种因素共同作用的结果。

And the reason it fell is a combination of a couple of different things.

接种率从疫情期间开始下降，主要是由于基础设施方面的原因。

It started to fall during the pandemic because of sort of infrastructure.

你知道，诊所都关闭了。

You know, clinics were closed.

人们无法到达诊所。

People couldn't get to the clinics.

此外，是反疫苗情绪的上升，而这种情绪在过去一年里确实变得更糟了。

And then also, yeah, the combination of sort of rising anti vaccine sentiment, and that certainly got worse this last year.

本月末，我们很可能将失去本国麻疹消除的资格。

And at the end of this month, we are most likely going to lose our status for measles elimination in this country.

因此，美国将不再被视为已消除麻疹。

So The United States will no longer be considered to have eliminated measles.

我认为，有一种观念认为健康儿童会 somehow 被排除在这些后果之外，受到保护，不会受到麻疹等疾病上升的影响，认为这些疾病只会或主要影响免疫系统较弱的病孩，但事实并非如此。

There's this idea, I think, that that healthy children will somehow be sort of excluded from these consequences, protected from these consequences, that the rising tide of illnesses like measles will sort of only or predominantly affect sick kids with weakened immune systems, and that's just not been true.

我认为，这属于肯尼迪及其支持者对疫苗减少的国家可能发生情况的一种看法。

I think it's been part of the sort of Kennedy and Kennedy aligned thinking on what might happen in a country with fewer vaccines.

但我们看到的是，健康儿童也感染了这些病毒，并因此病得很重。

But what we've seen is that healthy children too have been stricken with these viruses and gotten very sick from them.

例如，在过去几个冬天，我们看到季节性流感给美国儿童带来了巨大的损失。

We've seen, for example, in the last couple winters that the seasonal flu has exacted a really high toll on American children.

去年冬天，有数百名儿童死于流感，这是十多年来的最高死亡人数。

Hundreds of kids died last winter from the flu, which was the highest toll in more than a decade.

今年的流感病毒同样极具破坏性。

This year's flu is again a really devastating virus.

因此，疫苗接种率下降的后果，我们已经看到它们正在美国儿童身上显现。

And so the consequences of lower vaccination rates, we're already seeing them play out among American children.

还有另一件大事，让一些我接触过的公共卫生专家深感忧虑，那就是我国的疫苗责任保护计划。

And there's one other giant thing that is really weighing on the minds of some of the public health experts that I've been talking to, which is the vaccine liability protection program we have in this country.

基本上，生产疫苗的公司受到保护，免受法律上称为‘无根据诉讼’的起诉。

So, basically, companies that make vaccines are protected from what legal authorities call frivolous lawsuits.

这意味着人们不能随意起诉这些公司。

Meaning, people can't just go sue these companies willy nilly.

这项计划之所以设立，是因为疫苗并不是利润丰厚的产品。

And that was put in place because vaccines are not huge profit makers.

而且公司

And companies

利润并不高。

The margins are not that great.

利润并不高。

The margins are not that great.

由于这些诉讼，公司发现很难正常运营。

And companies were finding it very difficult to go about their business because of these lawsuits.

因此，他们建立了一个系统，让公司为其生产的疫苗缴纳税款。

And so they basically set up the system where companies pay a tax for the vaccines that they make.

而认为自己受到伤害的人可以向疫苗法庭提起诉讼，获得经济赔偿。

And people who think they've been harmed can take their case to this vaccine court and get financial compensation.

这一制度自1986年以来一直存在，以确保疫苗公司继续从事这一行业。

That system has been there since 1986 to make sure that vaccine companies stay in the business.

有人质疑，将这六种疫苗从常规接种计划中移除是否会影响整个体系。

There is some question about whether taking these six shots out of the routine vaccination schedule affects that whole thing.

到目前为止，看起来应该没问题，但这仍然是一个开放性问题。

So far, it seems like it should be okay, but that's still an open question.

而且企业正在密切关注这一点，因为疫苗的利润并不高。

And companies are really watching this very closely because vaccines are not that profitable.

在某些时候，如果在美国经营变得非常困难，他们可能会决定不再在美国开展业务。

And at some point, if things get very difficult for them to do business in The United States, they may decide to just not do business here.

这意味着公司可能会说，责任风险太高了。

Meaning that the companies might say, the liability is too high.

利润率太低了。

The margins are too small.

在美國生產這種疫苗不值得，因此，即使你想要這六種被移除的疫苗之一，你也可能無法獲得。

It's not worth us to manufacture this vaccine in The United States, ergo, even if you wanted one of these six shots that's been removed from the list, you might not be able to get it.

那将是最糟糕的情况，纯属推测，目前尚未提上议程，但你指的就是这个。

That would be the worst case scenario that highly speculative, not on the table yet, but that's what you're referring to.

完全是推测。

Absolutely speculative.

我们还远没有到那一步，但这是一个真正的担忧，因为这确实是个严重的问题。

We're not anywhere near there yet, but that is the big worry because it's a it's a real worry.

本，你对RFK的这种做法怎么看？

Ben, what do you make of RFK's approach here?

因为从我们之前讨论的所有内容来看，这些似乎都是有意义的调整，是对疫苗接种计划的重要修订，可能最终会产生一些长期影响，但就即时变化而言，这一步仍然比可能的幅度要小。

Because from everything we've been talking about, it seems like these are both meaningful changes, a meaningful revision to the vaccine schedule that might eventually have some long term consequences, but also a smaller step than it could have been in terms of immediate change.

我认为我们听到的，以及阿波尔瓦刚刚描述的，是肯尼迪部长在应对美国疫苗相关政治现实时所做出的一些让步。

I think part of what we hear and what Apoorva was just describing was some of the concessions that secretary Kennedy has made to the sort of political realities around vaccines in this country.

他仍然为那些认为孩子有必要接种疫苗的家长和医生保留了接种渠道。

He is maintaining access to the shots for parents and physicians who decide that they're warranted for kids.

他保留了保险覆盖。

He's keeping insurance coverage in place.

他尚未取消这些主要疫苗的责任保护。

He's not yet stripping liability protections from these major shots.

我认为这种政治现实是：疫苗在美国大多数民众中仍然很受欢迎。

And I think that political reality is that vaccines are still popular among the majority of Americans.

尽管支持率正在收窄，越来越多的共和党人，尤其是支持MAGA的共和党人，对疫苗越来越不信任，但大多数美国人仍然认为儿童疫苗非常有效且安全。

The majority of Americans still believes that childhood vaccines are highly effective and safe even as those margins are getting narrower and more and more Republicans, especially MAGA supporting Republicans, are growing more distrustful of vaccines.

因此，一方面，肯尼迪面临着这种公众舆论环境，这使得他对美国疫苗计划采取过于激进的措施在政治上存在一定风险。

So on the one hand, Kennedy has this sort of state of public opinion, which makes it politically somewhat risky to take too big a sledgehammer to the sort of American vaccine program.

另一方面，肯尼迪的核心支持者——那些多年来一直与他并肩作战的坚定反疫苗活动人士——正在为他筹款，并通过外部团体支持他的议程，这些活动人士多年来一直出现在他的播客中，宣传他们对疫苗的反对立场。

On the other hand, though, there is Kennedy's base, the sort of very committed anti vaccine activists who have been working at Kennedy's side for years, who are raising money for him, working for sort of outside groups supporting his agenda, the sort of activists who were on his podcast for years promoting their opposition to vaccines.

我认为，过去一年里，这些人有时对肯尼迪部长在疫苗计划变革上的步伐感到有些不耐烦。

And those folks, I would say, over the last year have gotten a little bit impatient with secretary Kennedy at times about the sort of pace of changes to the vaccine program.

他们觉得，我们帮助肯尼迪上台，就是为了用推土机彻底摧毁美国的疫苗体系，为什么他到现在还没动用这台推土机呢？

They felt like we helped put Kennedy in power to sort of take this bulldozer to the American vaccine program, and why isn't he yet using that bulldozer?

但就这一点而言，我不禁想知道，这一群体对这一消息的反应如何？我猜想，这远未达到他们希望他采取的力度。

And to that point, though, I wonder how is that base reacting to this news, which I would imagine is not as far as they would want him to go.

这或许能告诉我们，在他的领导下，未来我们可能会期待什么？

And what does that maybe tell us about what we might expect in the future under his leadership?

我认为，他们对肯尼迪在疫苗接种计划中砍掉这一大块内容的做法感到鼓舞。

I think they've been encouraged by how far Kennedy went and sort of taking this chunk out of the the vaccine schedule.

但他们并没有沾沾自喜。

But they're not resting on their laurels.

他们还没有自我庆祝。

They're not sort of patting themselves on the back yet.

他们希望看到更多。

They want to see more.

他们迫切要求采取更多行动。

They're clamoring for more action.

他们对新冠疫苗高度关注，肯尼迪的盟友将此归咎于导致许多美国人患病，尽管该疫苗仍被证明是安全有效的。

They are highly concerned about the COVID shot, which those allies of Kennedy blame for sickening many Americans despite that shot remaining safe and effective.

因此，我认为公共卫生专家和肯尼迪的支持者都在将明年视为一个试验场，以观察肯尼迪在瓦解国家疫苗计划方面能走多远。

So I think public health experts and Kennedy supporters alike are sort of looking to this next year as a testing ground for how far Kennedy can afford to go in dismantling the country's vaccine program.

肯尼迪正走在一条微妙的平衡路上，一边是支持者的要求，另一边是公众对限制疫苗接种所能容忍的限度。

Kennedy is walking a fine line between the demands of his base and sort of what public opinion will tolerate in terms of new restrictions on vaccine access.

关于他愿意走多远，以及特朗普总统会在多大程度上支持他推行这一议程，仍有许多未解之谜。

And there are a lot of open questions about how far he's willing to go and how much support president Trump will deliver him in enacting that agenda.

阿波尔瓦，本，非常感谢你们两位。

Aporva, Ben, thank you both so much.

谢谢。

Thank you.

谢谢，蕾切尔。

Thanks, Rachel.

我们马上回来。

We'll be right back.

以下是今天您需要了解的其他内容。

Here's what else you need to know today.

ICE，滚出明尼阿波利斯。

To ICE, get the fuck out of Minneapolis.

我们不想要你们在这里。

We do not want you here.

明尼阿波利斯市长雅各布·弗莱要求联邦移民官员立即离开该市，此前一名ICE特工在周三开枪射杀了一名在车内美国公民。

The mayor of Minneapolis, Jacob Fry, is demanding that federal immigration officials immediately leave the city after an ICE agent shot and killed a US citizen in her car on Wednesday.

你们声称来到这座城市是为了创造某种安全，但你们实际上正在做完全相反的事情。

Your stated reason for being in this city is to create some kind of safety, and you are doing exactly the opposite.

有人死了。

Somebody is dead.

这责任在你们身上。

That's on you.

这起枪击事件发生在乔治·弗洛伊德2020年被警察杀害地点约一英里处。

The shooting occurred about a mile from the location where George Floyd was killed by police in 2020.

一名旁观者拍摄的视频显示，移民局官员要求一名女子下车。

A video recorded by a bystander shows ICE officers demanding that a woman get out of her car.

当她向前开车时，一名官员向她的车里开枪，目击者惊恐地尖叫。

When she drives forward, an officer fires into her car as witnesses scream out in horror.

你们做了什么？

What did you do?

你们。

You.

羞耻。

Shame.

羞耻。

Shame.

羞耻。

Shame.

羞耻。

Shame.

枪击事件发生后，国土安全部指控这名女性故意利用车辆作为武器。

After the shooting, the Department of Homeland Security accused the woman of weaponizing her vehicle.

这是一种国内恐怖主义行为。

It was an act of domestic terrorism.

我们的一名官员迅速采取行动，进行自卫射击，以保护自己和周围的人。

An officer of ours acted quickly and defensively shot, to protect himself and the people around him.

但城市官员驳斥了这一说法，抗议者迅速走上街头表达他们的愤怒。

But city officials disputed that claim, and protesters quickly took to the streets to express their outrage.

周三晚上，特朗普总统在椭圆形办公室接受《纽约时报》采访时暗示，美国在推翻委内瑞拉总统尼古拉斯·马杜罗后，将长期介入委内瑞拉事务。

And in an Oval Office interview with the Times on Wednesday night, president Trump suggested The United States would be involved in Venezuela for years following his ouster of its president, Nicolas Maduro.

你觉得你会经营这个房地产多久？

How long do you think you'll be running this real estate?

时间会证明一切。

Only time will tell.

比如三个月、六个月、一年，或者更久。

Like, three months, six months, a year, longer.

我会说要久得多。

I would say much longer.

久得多。

Much longer.

而且我们必须重建，我们必须重建这个国家，而且我们会以一种非常有利可图的方式重建它。

And Much We have to rebuild we have to rebuild the country, and we will rebuild it in a very profitable way.

与总统的这次访谈将成为明天节目节目的主题。

That interview with the president will be the subject of tomorrow's episode of the show.

本期节目由亚历克斯·斯特恩、奥利维亚·纳特、尼娜·菲尔德曼和陈思婷制作，并得到阿斯塔·查图尔维迪的帮助。

Today's episode was produced by Alex Stern, Olivia Natt, Nina Feldman, and Stella Tan, with help from Asta Chaturvedi.

本节目由克里斯·哈克尔和德文·泰勒剪辑，苏珊·李提供研究支持。

It was edited by Chris Haxle and Devin Taylor, with research help by Susan Lee.

节目音乐由玛丽安·洛萨诺和利娅·肖·德梅隆创作，由克里斯·伍德负责音频工程。

Contains music by Marian Lozano and Leah Shaw Demeron and was engineered by Chris Wood.

特别感谢凯尔·格兰迪洛。

Special thanks to Kyle Grandillo.

以上就是《每日新闻》的全部内容。

That's it for The Daily.

我是蕾切尔·阿布拉姆斯。

I'm Rachel Abrams.

明天见。

See you tomorrow.